This is the first study to comprehensively assess the state of obesity education in undergraduate medical education in the United States. This Medical School Curriculum Benchmark Study survey revealed inconsistent and inadequate obesity education in U.S. allopathic medical schools resulting in medical students being ill-prepared to manage patients with obesity. Despite the recognition of obesity as a disease by the American Medical Association (AMA) in 2013 and rising prevalence rates of the disease [16, 17], none of the core obesity competencies were well-covered by more than four in ten medical schools surveyed. The survey revealed that in approximately one-quarter to one-third of the medical schools surveyed, there was little to no coverage of rudimentary treatments for obesity, i.e., nutrition, behavioral, and physical activity interventions.
These data underline not only the limited coverage of obesity education, but also the lack of prioritization to develop future curricula in obesity. An overcrowded curriculum was reported as the major barrier to implementing obesity education in this study; however, external barriers, e.g., poor faculty knowledge about obesity, lack of standardized testing on obesity, and overall negative attitudes about the disease of obesity, are possible reasons why obesity education is not prioritized. Nutrition education, one facet of obesity education, is similarly underprioritized in undergraduate medical education. In a recent study of medical student perspectives on why nutrition education is inadequate in medical school, the perception that nutritional care is not the responsibility of doctors was suggested as a barrier [18]. Although our study did not obtain this information, the role of weight bias and the belief that obesity is the result of a voluntary lifestyle choice, and not a biologic disease, may influence decisions and opportunities of inclusion in medical school curricula.
To address the paucity of obesity education in U.S. medical schools, two recent educational initiatives included the development of core competencies in obesity in health care professional schools. First, the Provider Training and Education Workgroup, part of an activity associated with the Roundtable on Obesity Solutions at the National Academies, developed ten high-level provider competencies for the prevention and management of obesity for health care professional schools [19]. Secondly, OMEC, which is spearheaded by the Obesity Medicine Association, The Obesity Society, and the American Society of Metabolic and Bariatric Surgery, developed 32 obesity-related competencies and associated benchmarks across the six core domains of the Accreditation Council for Graduate Medical Education (ACGME). These obesity-related competencies were developed for medical undergraduate and postgraduate training programs to assess learners within a training program [14]. Competencies from both initiatives are the first step to evaluating obesity knowledge of health care professionals and developing a structure for standards of care.
Limitations
There are several limitations to our study including a response rate of approximately 30%; however, this is not unexpected given the target audience of medical school program leaders who have great demands on their time. To minimize response bias (i.e., inaccurate responses) in our survey, the instrument was designed in collaboration with a survey expert to design optimal questions; however, the survey was not validated, and response bias is possible. Non-responder bias, in which certain types of respondents are less likely to respond (for example, schools without a strong obesity program in place), is also a possibility, and could have skewed the results toward a more favorable outlook of obesity education in U.S. medical schools. We believe that positive skewing is unlikely given the findings of low prioritization of obesity education reported by the respondents. Some of the reported data are subjective, including extent that the obesity competencies are covered, student preparedness, and the prioritization of obesity education.
The design of this research places a greater importance on the number of institutions represented rather than the homogeneity of respondents. It is important to have homogeneity of the respondents, and we believe the deans of education and curriculum leaders were the most appropriate respondents. In our study, nearly all respondents taught medical students and more than 75% were very knowledgeable of their curriculum; however, we were unable to control for the influence of respondents’ varied roles and professional experience on their responses. Additionally, due to the difficulty of true random sampling, this research is limited by the extent to which our sample of 40 schools represents the true population of U.S. allopathic medical schools. Development of the list of contacts was dependent on publicly available information, and therefore, the number of contacts identified at each institution varied. However, our survey sample closely aligned to the composition of the current medical schools in the U.S. with regards to regional distribution and source of funding (public/private). Thus, we believe the sample we obtained represents the population in question (U.S. allopathic medical schools).